What Causes Nursing Home Abuse?
With such a high prevalence of nursing home abuse cases, it may seem alarming that it continues to occur. However, change cannot occur until the reasons why nursing home abuse occurs are thoroughly examined and rectified.
There are many reasons why nursing home abuse occurs. The causes of nursing home abuse largely depend on the individual nursing home, its quality, the caliber of care staff and overall facility management.
A nursing home lacking resources and professional management and supervisions is difficult to operate. This causes the quality of care to suffer and perpetuates neglect and even abuse.
The types of residents and their unique needs also play a role in how nursing home abuse is carried out. High-need patients, women, veterans and LGBT residents are at greater risk of being abused. Patients with severe physical and cognitive disabilities are also targets of abuse and neglect.
Below are some of the top reasons why experts feel that nursing home abuse occurs:
- Staffing shortages
- Lack of staff training and experience
- Underpaid staff
- Poor supervision, management and accountability
- Individual caregiver issues
- Individual resident risk factors
Nursing homes can only operate to the best of their ability if they have the staff required to fulfill their duties. Staff can only provide the highest possible standard of care if they are supported by other staff and are working in a team environment.
As soon as any organization—especially a nursing home—faces a staff shortage, responsibilities get dropped, standards of care fall and certain duties are neglected. This is because staff members are forced to start prioritizing certain needs of residents over others. Over time, this neglect can lead to long-term failure to provide basic needs which can constitute abuse.
When a nursing home is chronically understaffed, it creates a stressful and hostile environment. The staff may even become disgruntled and bitter, feeling unsupported and ill-equipped to do their jobs.
Understaffing is especially bad across the nursing home industry.
“Most of the bad outcomes are the result of insufficient staffing and insufficiently trained staff. It’s pretty much a universal problem,” said Toby Edelman, senior policy attorney for the Center for Medicare in Washington, D.C., in a 2018 interview with the Hartford Courant.
A low ratio of caregivers to residents means the existing staff is more likely to miss severe issues. Other staff members may take their frustration out on residents, which can occur through physical or verbal abuse.
The CMS announced in late 2018 that it would take new measures to prevent understaffing, using payroll data to determine what nursing homes are understaffed. It is still unclear how these measures will play out.
Nursing homes may have a full line of staff. However, if the individual staff members are not properly trained or do not have the experience, they cannot perform all of their job duties. Additionally, if the staff does not receive ongoing training to adapt to the shifting needs of residents, they cannot provide the necessary care required.
Improper training ultimately impacts residents and their quality of life. Staff must have the experience and education to know how to provide personal care, medical attention and other supports for elderly people. Without this training, a number of unfortunate consequences can ensue.
A lack of support and care is considered nursing home neglect. If the situation worsens and residents are deprived of basic needs, it may be considered nursing home abuse.
Undertrained staff can come in many forms:
- Not having the required educational and vocational training
- Not having a work experience background in a nursing home environment
- Not being trained on the specific policies of the nursing home
- Lack of understanding of the rights of residents
- Lack of ongoing, on-the-job training and development
- Inadequate training for specific disabilities, illnesses and needs
Additionally, it is commonly reported that nursing home staff members feel as though they do not have the tools they need to handle aggressive or violent residents. A common symptom of old age is developing aggressive behavior due to cognitive decline. Many elderly residents direct their aggression towards their caretakers, typically unknowingly.
Care staff who do not have the proper training and experience may retaliate or misunderstand the intent. As a result, some may feel more inclined to act abusively or neglectfully towards those particular residents.
The majority of nursing homes are privately run businesses. Because of this, there are not across-the-board standards for pay rates for staff. In turn, some nursing home staff members are paid more than others depending on the nursing home.
Many nursing home caregiving staff members feel underpaid and undervalued. Therefore, they are not motivated to provide high levels of care. Without motivation to provide a certain standard of care, many residents become neglected or abused by staff who do not feel compelled to help or go above and beyond. Over time, this leads to low morale which creates a culture of accepting low standards of care.
Other Caregiver Issues
Occasionally, there are circumstances where nursing homes are well-run with a full staff of highly trained and properly screened personnel. However, there are rogue individuals who commit abuse for their own personal reasons.
Like anywhere in society, there are always certain individuals who are more likely to act in a neglectful or abusive way towards others. Sometimes, these people work in nursing homes directly with senior citizens.
There are countless reasons why these individuals commit abuse. Generally, these caregivers have issues of their own that are contributing factors as to why they may justify abusive and neglectful actions.
Individual caregiver issues that cause nursing home abuse may include:
- Burnout and stress
- Personal issues at home such as divorce or financial troubles
- Poor personal health and illness
- Mental illness
- Personal history of being abused
Because these individuals are dealing with their own personal issues, they may bring their frustration to work. Instead of having outlets for their frustration, they act abusively towards their residents who are seen as easy targets.
Poor Nursing Home Management
Another reality of nursing homes is that some of them are simply run better than others. If nursing homes do not have the leadership, management and supervision required to run a safe operation, standards slip and neglect can easily occur.
Additionally, if nursing home management does not set high levels of accountability in regard to resident care, staff may not feel compelled to provide it. A continued lack of accountability and leadership breeds an environment where neglect and abuse can continue without consequence.
Lack of Consequences
One of the biggest reasons that abuse in nursing homes continues is a widespread lack of punishments. Even when reported, cases of nursing home abuse may go uninvestigated or unpunished by local and state authorities. This vicious cycle allows many nursing homes to continue to operate despite repeated incidence of abuse, neglect or exploitation.
A notable example of this was exposed recently in Florida. A 2018 study conducted by reporters at Naples Daily News surveyed 43 cases detailing nursing home deaths in the previous five years. The cases reported on deaths directly caused by abuse or neglect from the staff.
Additionally, when nursing homes are punished in the state, the fines are usually under six figures, which amount to mere slaps on the wrist.
Sadly, this problem is not just confined to Florida. The effects are seen across the nursing home industry.
Fortunately, there are steps being taken to punish nursing homes that do not meet government standards. A new provision recently cut funding from 11,000 nursing homes that receive Medicare funding.
The cuts were determined by how many patients went to the hospital within 30 days after leaving the facility.
While new policies on nursing homes continue to be updated, action from citizens can spur nursing homes into taking proper care of their residents.
Resident Risk Factors for Nursing Home Abuse
There are also risk factors that make certain residents more susceptible to being abused and neglected.
Residents who are seen as needier, more time-consuming or different in some way from other residents are more likely to be abused or neglected. Some of the risk factors that make certain residents more like to be subjected to nursing home abuse are outlined below.
- Cognitive Illnesses: Residents with cognitive disorders like Alzheimer’s Disease or dementia may require more work because the disorders present a communication barrier for staff.
- Mental Illness: Residents who have suffered past traumas or who have depression, anxiety or bipolar disorder may be more susceptible to both being abused and perpetuating abuse.
- Physical Disabilities: Physical disabilities provide an additional challenge for care staff. These residents require additional care, eliciting feelings of frustration in some caregivers.
- Access to Wealth: Residents who are known to be wealthy or have access to wealth are more likely to be targets of financial abuse in nursing homes.
- Being Female: Women are more likely than men to be abused in nursing homes. This is because women are commonly perceived to be easier targets and because women live longer. There are also statistically more women than men residing in nursing homes.
- Having Additional Needs: Individuals with additional needs that go above and beyond the average resident are more likely to face different forms of neglect or even abuse over time.
There are countless other factors at play in regard to why nursing home abuse and neglect occur. Each nursing home operates under its own policies and procedures. Often times, this determines whether abuse will take place or not.
It is important to do extensive research when selecting a nursing home. Look into staffing levels, staff wages, management style and the nursing home’s history to get a better feel for its overall care philosophy.